Nasal surgery operations are performed using either closed or open rhinoplasty access. Discussions about the best rhinoplasty option continue not only on rhinosurgery forums, but also in the plastic surgeon community. Some experts believe that most problems of an aesthetic and/or functional nature are better resolved with the help of closed rhinoplasty; others have a different point of view and more often operate on patients with an open method.
Which method is better - open or closed rhinoplasty? The proposed publication discusses the main features of each rhinoplasty access variant, the main advantages of the methods and their disadvantages.
The main difference between the methods considered is the location of the surgical approach. Closed rhinoplasty is performed through an internal access. The incisions pass through the mucous membrane of the nasal passages, the skin of the wings and columella are not damaged. With this option, the plastic surgeon, in fact, obtains two independent accesses to the deep anatomical formations of the left and right half of the nasal skeleton, which slightly worsens the visibility of the surgical field.
Open rhinoplasty is performed through an external access. The incisions pass through the skin of the thin septum between the nasal passages (called the columella) and the wings. A longer and mostly continuous incision allows the plastic surgeon to move the skin from the tip to the bridge of the nose and get an excellent view of the internal anatomical structures (cartilage, bones) that need to be changed. After correction, small scars remain at the incision site, which eventually become almost invisible.
Open plastic: characteristics of the method
According to patients, the main disadvantage of open rhinoplasty is that, after correction, small scars remain on the skin of the caudal parts of the nose. Although post-operative scars are almost imperceptible, and after the rehabilitation period is over it is almost impossible to see them, many are confused by the very fact of their presence. This forces patients to seek out specialists who are ready to perform a correction in a closed manner.
For a plastic surgeon, the minimization or total absence of visible scars on the skin is also of no small importance, but other characteristics of the technique come to the fore for a specialist. Open rhinoplasty is associated with damage to the columella, and this is a very significant disadvantage, not only in terms of scarring, but also in terms of the long-term aesthetic consequences of the surgical intervention.
Why is damage to the thin skin bridge between the nasal passages important? Columella performs important functions. Within this anatomical formation are the blood vessels - arteries, veins - through which nutrients and oxygen enter the distal tip of the nose.
Columellar arteries are responsible for tissue trophism and therefore their safety during plastic surgery affects the dynamics of the recovery period. Columellar veins drain venous blood. Its damage is fraught with deterioration of drainage function and increased congestion, which is manifested by greater severity and persistence of swelling of the tip of the nose after surgery.
The second aspect is related to the fact that the columella plays a supporting role. It is a kind of "support" that keeps the tip in the correct anatomical position. During an open operation, the supporting function of the columella can be impaired, which in theory (and in practice) in the long or medium term can lead to an aesthetic complication in the form of tip drop.
Thus, the main disadvantages of open rhinoplasty are as follows:
- Columellar arteries are damaged, which worsens the dynamics of the recovery period, increases the severity and duration of edema.
- The supporting function of the columella deteriorates, resulting in the risk of an aesthetic complication in the form of tip drop.
- Small scars remain on the skin.
There is an open method and advantages. The key is that a continuous, extended (relatively extended) incision allows the surgeon to fully open the surgical field and gain good access to the anatomical formations of the nasal skeleton. When complex manipulations of deep elements are required, a good view of the surgical field plays a decisive role. It is very important during secondary or reconstructive repair after a severe fracture and therefore such interventions are almost always performed in an open manner.
Closed method: features
Are the advantages and disadvantages of closed rhinoplasty a mirror image of the pros and cons we talked about in the previous section? To some extent, it is.
Closed rhinoplasty is accompanied by less trauma to the soft tissues. The columella is not dissected, respectively, the veins and arteries that bring nutrients and oxygen, and through which tissue fluid drains from the tip, are not damaged. As a result, after closed rhinoplasty, recovery is usually faster. Edema is less pronounced and passes faster.
The risk of cosmetic complications in the form of tip drop is much lower. There are no visible scars on the skin, which for many patients becomes a clincher in favor of closed rhinoplasty.
Advantages of the closed method:
- Less bleeding, less pronounced damage to the soft tissues of the caudal parts of the nose.
- The arteries and veins responsible for supplying blood to the tip are not damaged.
- Columella support function is preserved, there is no risk of tip falling off after correction.
- There are no scars on the skin.
- Recovery after surgery is faster. Edema is less pronounced and passes faster.
The disadvantage of the closed method is its limited capacity. Yes, many aesthetic problems can be solved with a closed operation, but unfortunately, not all. Revision plasty requires a complete view of the surgical field and therefore, in repeated operations, open rhinoplasty is more often used.
Tip repair, despite its apparent simplicity, often also requires the use of an open incision. If it is necessary to install large grafts to model the shape and correct a defect, the surgeon must use external incisions, as it is sometimes not possible to install large implants through an internal approach.
The choice between open and closed rhinoplasty is largely determined by the specifics of the problem with which the patient went to the plastic surgeon. If a high aesthetic result can only be obtained with external incisions, the surgeon opts for the open method. If the correction can be carried out through external and internal incisions, a closed operation is preferable.
You will receive detailed information about the features, disadvantages and advantages of closed and open rhinoplasty in an individual consultation with a plastic surgeon.